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BACKGROUND: Childhood maltreatment is associated with elevated adult weight. It is unclear whether this association extends to pregnancy, a critical window for the development of obesity. METHODS: We examined associations of childhood maltreatment histories with pre-pregnancy BMI and gestational weight gain among women who had participated for >20 years in a longitudinal cohort.At age 26-35 participants reported childhood maltreatment (physical, sexual, and emotional abuse; emotional neglect) and, 5 years later, about pre-pregnancy weight and gestational weight gain for previous pregnancies (n=656). Modified Poisson regression models were used to estimate associations of maltreatment history with pre-pregnancy BMI and gestational weight gain z-scores, adjusting for sociodemographics. We used Multivariate Imputation by Chained Equations to adjust outcome measures for misclassification using data from an internal validation study. RESULTS: Before misclassification adjustment, results indicated a higher risk of pre-pregnancy BMI ≥30 kg/m2 in women with certain types of maltreatment (e.g., emotional abuse RR=2.4; 95% CI: 1.5, 3.7) compared with women without that maltreatment type. After misclassification adjustment, estimates were attenuated but still modestly elevated (e.g., emotional abuse RR=1.7; 95% CI: 1.1, 2.7). Misclassification-adjusted estimates for maltreatment associations with gestational weight gain z-scores were close to the null and imprecise. CONCLUSIONS: Findings suggest an association of maltreatment with pre-pregnancy BMI ≥30 kg/m2 but not with high gestational weight gain. Results suggest a potential need for equitable interventions that can support all women, including those with maltreatment histories, as they enter pregnancy.
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The mental health impact of disasters is substantial, with 30-40% of direct disaster victims developing post-traumatic stress disorder (PTSD). It is not yet clear why some people cope well with disaster-related trauma while others experience chronic dysfunction. Prior research on non-disaster trauma suggests that an individual's history of traumatic experiences earlier in the life course, prior to the disaster, may be a key factor in explaining variability in psychological responses to disasters. This study evaluated the extent to which pre-disaster trauma predicts PTSD trajectories in a sample of Hurricane Katrina survivors followed for 12 years after the storm. Four PTSD trajectories were identified using latent class growth analysis: Resistant (49.0%), Recovery (29.3%), Delayed-Onset (8.0%), and Chronic-High (13.7%). After adjusting for covariates, pre-Katrina trauma had only a small, positive impact on the probability of long-term, chronic Katrina-specific PTSD, and little effect on the probability of the Resistant and Delayed-Onset trajectories. Higher pre-Katrina trauma exposure moderately decreased the probability of being in the Recovery trajectory, in which Katrina-specific PTSD symptoms are initially high before declining over time. When covariates were added to the model one at a time, the association between pre-Katrina trauma and Chronic-High PTSD was attenuated most by the addition of Katrina-related trauma. Our findings suggest that while pre-disaster trauma exposure does not have a strong direct effect on chronic Katrina-specific PTSD, pre-Katrina trauma may impact PTSD through other factors that affect Katrina-related PTSD, such as by increasing the severity of Katrina-related trauma. These findings have important implications for the development of disaster preparedness strategies to diminish the long-term burden of disaster-related PTSD.
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Tempestades Ciclônicas , Transtornos de Estresse Pós-Traumáticos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Sobreviventes/psicologia , Desastres , Adulto Jovem , IdosoRESUMO
BACKGROUND: Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are determinants of maternal and child health. However, many studies of these factors rely on error-prone self-reported measures. METHODS: Using data from Life-course Experiences And Pregnancy (LEAP), a US-based cohort, we assessed the validity of prepregnancy BMI and GWG recalled on average 8 years postpartum against medical record data treated as alloyed gold standard ("true") values. We calculated probabilities of being classified into a self-reported prepregnancy BMI or GWG category conditional on one's true category (analogous to sensitivities and specificities) and probabilities of truly being in each prepregnancy BMI or GWG category conditional on one's self-reported category (analogous to positive and negative predictive values). RESULTS: There was a tendency toward under-reporting prepregnancy BMI. Self-report misclassified 32% (95% confidence interval [CI] = 19%, 48%) of those in LEAP with truly overweight and 13% (5%, 27%) with obesity into a lower BMI category. Self-report correctly predicted the truth for 72% (55%, 84%) with self-reported overweight to 100% (90%, 100%) with self-reported obesity. For GWG, both under- and over-reporting were common; self-report misclassified 32% (15%, 55%) with truly low GWG as having moderate GWG and 50% (28%, 72%) with truly high GWG as moderate or low GWG. Self-report correctly predicted the truth for 45% (25%, 67%) with self-reported high GWG to 85% (76%, 91%) with self-reported moderate GWG. Misclassification of BMI and GWG varied across maternal characteristics. CONCLUSION: Findings can be used in quantitative bias analyses to estimate bias-adjusted associations with prepregnancy BMI and GWG.
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Índice de Massa Corporal , Ganho de Peso na Gestação , Rememoração Mental , Autorrelato , Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Estudos de Coortes , Estados UnidosAssuntos
Negro ou Afro-Americano , Armas de Fogo , Violência com Arma de Fogo , Homicídio , Mortalidade , População Rural , Adolescente , Criança , Feminino , Humanos , Masculino , Negro ou Afro-Americano/estatística & dados numéricos , Armas de Fogo/estatística & dados numéricos , Violência com Arma de Fogo/etnologia , Violência com Arma de Fogo/estatística & dados numéricos , Violência com Arma de Fogo/tendências , Homicídio/etnologia , Homicídio/estatística & dados numéricos , Homicídio/tendências , Mortalidade/etnologia , Mortalidade/tendências , População Rural/estatística & dados numéricos , População Rural/tendências , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , População Urbana/tendências , Brancos/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Ferimentos por Arma de Fogo/mortalidadeRESUMO
BACKGROUND: Life course factors may be associated with pre-pregnancy body mass index and gestational weight gain; however, collecting information on pre-pregnancy exposures and pregnancy health in the same cohort is challenging. OBJECTIVES: The Life-course Experiences And Pregnancy (LEAP) study aims to identify adolescent and young adult risk factors for pre-pregnancy weight and gestational weight gain (GWG). We built upon an existing cohort study to overcome challenges inherent to studying life course determinants of pregnancy health. POPULATION: Participants in an ongoing prospective cohort study of weight-related health who identified as women. DESIGN: Retrospective cohort study. METHODS: In 2019-2020, 1,252 women participating since adolescence in a cohort study of weight-related health were invited to complete an online reproductive history survey. Participants who reported a live birth were invited to release their prenatal, delivery, and postpartum medical records for validation of survey reports. Descriptive analyses were conducted to assess the characteristics of the overall cohort and the medical record validation subsample, and to describe adolescent and young adult characteristics of those with high (>80th percentile), moderate (20th-80th percentile), and low (<20th percentile) GWG z-score for gestational age and pre-pregnancy weight status. PRELIMINARY RESULTS: Nine hundred seventy-seven women (78%) completed the LEAP survey and 656 reported a live birth. Of these, 379 (58%) agreed to release medical records, and 250 records were abstracted (66% of the 379). Of the 977 survey respondents 769 (79%) reported attempting a pregnancy, and 656 (67%) reported at least one live birth. The validation subsample was similar to the overall cohort. Women with a high GWG had a higher adolescent BMI percentile and prevalence of unhealthy weight control behaviors than those with moderate or low GWG. CONCLUSIONS: LEAP offers a valuable resource for identifying life course factors that may influence the health of pregnant people and their offspring.
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Ganho de Peso na Gestação , Adulto Jovem , Adolescente , Gravidez , Feminino , Humanos , Estudos Retrospectivos , Estudos de Coortes , Estudos Prospectivos , Acontecimentos que Mudam a Vida , Saúde Reprodutiva , Nascido Vivo , Índice de Massa Corporal , Resultado da Gravidez/epidemiologiaRESUMO
INTRODUCTION: Firearms are now the number one killer of children and adolescents in the United States. Firearm homicides among Black male youth are the driver of this increase. Prevention requires a multi-faceted life course approach. Academic achievement has been identified as a protective factor. Early childhood education, which is linked to later achievement, is thus an intervention area of interest. Conceptualizing the potential links between early childhood education and reduced risk for youth firearm homicide is important for guiding policy advocacy and informing future research. METHODS: This paper presents a conceptual model linking early childhood education to reduced risk for firearm homicide. Each link in the model is discussed, and a corresponding review of the literature is presented. The need for anti-racist policies to strengthen the impact of early childhood education is highlighted. RESULTS: Early education and firearm homicide research are each well-established but largely disconnected. There are clear immediate benefits of early childhood education; however, these effects wane with time, particularly for youth of color. At the same time, juvenile delinquency-a major risk factor for firearm homicide-is influenced by educational inequities. CONCLUSIONS: Effective interventions to reduce firearm homicides among Black male youth in the United States are needed. Early childhood education shows promise as an intervention. However, to have an impact, this education needs to be accessible and affordable for all, particularly families of color and low income. Societal structures and policies must also better support the positive gains seen through early childhood education to avoid dissipation.
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Sucesso Acadêmico , Armas de Fogo , Adolescente , Criança , Pré-Escolar , Humanos , Masculino , Escolaridade , Homicídio/prevenção & controle , Estados Unidos , Negro ou Afro-AmericanoRESUMO
BACKGROUND: Growing evidence on the long-term deleterious impacts of emotional abuse highlights the need to further understand childhood emotional abuse and its context to strengthen prevention efforts. OBJECTIVE: To describe emerging adults' experiences of emotional abuse in their childhoods and the household context surrounding that abuse. PARTICIPANTS AND SETTING: Fifty-eight interviews were conducted with emerging adults, ages 18-25, recruited from four 2- and 4-year institutions of higher education. METHODS: Thematic analysis was conducted to identify and describe patterns in the data. A cyclical approach to codebook development and data analysis was followed by a team of four coders. RESULTS: Themes related to participants' experiences of emotional abuse included: inability to meet parent expectations; parent attacks on the child's character; parent negative comparisons to siblings and others; parent invalidation of the child's emotions and mental health needs; and evolution over time in the parent-child relationship. Aspects of childhood family environments contemporaneous with the childhood emotional abuse included: financial stress; parent mental illness; parent divorce, separation, or volatile relationship; parent adversity or trauma; physical abuse; and young parent age. Many participants identified these aspects of their family environment, most of which could potentially be improved with sufficient support, as playing causal roles in the emotional abuse they experienced. CONCLUSION: This descriptive qualitative study provides additional insight into child emotional abuse and its associated factors, providing invaluable insights that can enhance current measurement and intervention approaches.
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Maus-Tratos Infantis , Transtornos Mentais , Criança , Humanos , Adulto , Adolescente , Adulto Jovem , Abuso Emocional , Maus-Tratos Infantis/psicologia , Emoções , Estudantes/psicologiaRESUMO
OBJECTIVE: A growing body of literature suggests that the COVID-19 pandemic is a traumatic stressor capable of causing posttraumatic stress symptoms. People with a history of trauma, particularly those with posttraumatic stress disorder (PTSD), may be particularly vulnerable to the negative mental health impacts of the pandemic. However, qualitative research exploring potential differences in the lived experiences of and reactions to COVID-19 between people with and without PTSD is lacking. METHOD: Semistructured interviews were conducted with 31 women (n = 15 women with probable PTSD, n = 16 women without probable PTSD) recruited from an ongoing U.S.-based cohort study. Themes were identified using inductive thematic analysis. RESULTS: The majority of women with PTSD described their level of fear or perceived safety related to COVID-19 as a major factor influencing their mental health during the pandemic. In contrast, women without PTSD indicated that their level of distress was largely driven by pandemic-related restrictions on normal activities and family events. Many women with PTSD also described feeling anger or frustration toward people they perceived as not taking the COVID-19 pandemic seriously. Only one participant without PTSD expressed similar feelings. CONCLUSIONS: This study found notable differences in reactions to the COVID-19 pandemic between people with and without PTSD, with findings that are likely relevant to future disasters. These findings can inform the development of preparedness policies for future disasters, pandemics, or other collective traumas to prevent distress and improve mental health, particularly for vulnerable populations such as individuals with preexisting PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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INTRODUCTION: Despite research showing substantial weight disparities along the rural-urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time. METHODS: Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates. RESULTS: Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5-5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9-3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time. CONCLUSIONS: These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.
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Sobrepeso , Complicações na Gravidez , Gravidez , Feminino , Humanos , Sobrepeso/epidemiologia , Minnesota/epidemiologia , População Rural , Aumento de Peso , Obesidade/epidemiologia , Índice de Massa Corporal , Complicações na Gravidez/epidemiologiaRESUMO
OBJECTIVE: Low childhood socio-economic status (SES) and adverse childhood experiences (ACE) are associated with poor health outcomes in adulthood. Determining how ACE may be linked to food insecurity among young people from socio-economically diverse households can inform health-protective strategies. This study examined if ACE are associated with food insecurity during the transition to adulthood and investigated prevalence differences across SES strata. SETTING: Participants were recruited from twenty secondary schools in Minneapolis-St. Paul, Minnesota. PARTICIPANTS: The analytic sample (n 1518) completed classroom surveys in 2009-2010 (mean age = 14·5 years) and follow-up surveys in 2017-2018 (mean age = 22·0 years). DESIGN: Past-year food insecurity was reported at both time points, and ACE were reported at follow-up. Logistic regression models were used to estimate emerging adult food insecurity prevalence by ACE exposure; models were stratified by childhood SES (low, middle and high). RESULTS: The adjusted prevalence of food insecurity was 45·3 % among emerging adults who reported three or more ACE compared with 23·6 % among those with one or two ACE and 15·5 % among those with no ACE (P < 0·001). All forms of ACE were related to an elevated prevalence of food insecurity in emerging adulthood. ACE-food insecurity associations were strongest for emerging adults from lower and middle SES households. Among emerging adults from low SES households, childhood experiences of emotional abuse and substance use by a household member were associated with the largest prevalence differences in food insecurity. CONCLUSIONS: Findings suggest a need for trauma-informed services within food assistance programs to better serve individuals with a history of ACE.
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Experiências Adversas da Infância , Adulto , Humanos , Adolescente , Adulto Jovem , Características da Família , Inquéritos e Questionários , Minnesota , Insegurança Alimentar , Abastecimento de AlimentosRESUMO
Background: Gonorrhea incidence in the United States has risen by nearly 50% in the last decade, while screening rates have increased. Gonorrhea sequelae rates could indicate whether increased gonorrhea incidence is due to better screening. We estimated the association of gonorrhea diagnosis with pelvic inflammatory disease (PID), ectopic pregnancy (EP), and tubal factor infertility (TFI) in women and detected changes in associations over time. Materials and Methods: This retrospective cohort study included 5,553,506 women aged 18-49 tested for gonorrhea in the IBM MarketScan claims administrative database from 2013-2018 in the United States. We estimated incidence rates and hazard ratios (HRs) of gonorrhea diagnosis for each outcome, adjusting for potential confounders using Cox proportional hazards models. We tested the interaction between gonorrhea diagnosis and the initial gonorrhea test year to identify changes in associations over time. Results: We identified 32,729 women with a gonorrhea diagnosis (mean follow-up time in years: PID = 1.73, EP = 1.75, TFI = 1.76). A total of 131,500 women were diagnosed with PID, 64,225 had EP, and 41,507 had TFI. Women with gonorrhea diagnoses had greater incidence per 1000 person-years for all outcomes (PID = 33.5, EP = 9.4, TFI = 5.3) compared to women without gonorrhea diagnoses (PID = 13.9, EP = 6.7, TFI = 4.3). After adjustment, HRs were higher in women with a gonorrhea diagnosis vs. those without [PID = 2.29 (95% confidence interval, CI: 2.15-2.44), EP = 1.57, (95% CI: 1.41-1.76), TFI = 1.70 (95% CI: 1.47-1.97)]. The interaction of gonorrhea diagnosis and test year was not significant, indicating no change in relationship by initial test year. Conclusion: The relationship between gonorrhea and reproductive outcomes has persisted, suggesting a higher disease burden.
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Infecções por Chlamydia , Gonorreia , Doença Inflamatória Pélvica , Gravidez Ectópica , Gravidez , Feminino , Estados Unidos , Humanos , Gonorreia/epidemiologia , Infecções por Chlamydia/epidemiologia , Estudos Retrospectivos , Chlamydia trachomatis , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Doença Inflamatória Pélvica/complicações , Doença Inflamatória Pélvica/diagnóstico , Seguro SaúdeRESUMO
Background: This study examined the associations between BMI trajectories and emerging cardiometabolic risk (CMR) in children living in low-income and racially and ethnically diverse households in the United States. Methods: Data were drawn from NET-Works randomized intervention trial and NET-Works 2 prospective follow-up study (N = 338). BMI was measured across 6 follow-up visits and biomarkers of cardiometabolic risk (CMR) at the sixth visit. Group-based trajectory modeling identified child BMI trajectories. Adjusted multivariable linear regressions evaluated the associations between BMI trajectories and CMR. Results: We identified two BMI trajectories: 25% followed a trajectory of steep BMI increase, and 75% followed a moderate decreasing BMI trajectory over time. Relative to children in the moderate decreasing trajectory, children in the increasing trajectory had higher adjusted mean levels of C-reactive protein [CRP; 3.3; 95% confidence interval (CI): 1.6 to 5.0], leptin (63.1; 95% CI: 44.3 to 81.8), triglycerides (35.4; 95% CI: 22.1 to 48.6), triglyceride/high-density lipoprotein (HDL) ratio (1.2; 95% CI: 0.8 to 1.6), hemoglobin A1c (HbA1C; 0.1; 95% CI: 0.03 to 0.2), fasting glucose (1.8; 0.1 to 3.5) and insulin (8.8; 95% CI: 6.5 to 11.0), overall CMR score (0.7; 95% CI: 0.5 to 0.9), and lower adiponectin (-1.3; 95% CI: -2.5 to -0.1) and HDL (-10.8; 95% CI: -14.3 to -7.4). Conclusions: Children with high BMIs early in childhood were more likely to maintain an accelerated BMI trajectory throughout childhood, which was associated with adverse CMR in pre-adolescence. To advance health equity and support children's healthy weight and cardiovascular health trajectories, public health efforts are needed to address persistent disparities in childhood obesity and CMR.
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Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options.
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Economic hardship during childhood has been linked to poor physical and mental health. This study examines cross-sectional and longitudinal associations of a summed economic hardship score of poverty, food insecurity, and financial hardship with hair cortisol in young children. Data from 24-month (Time 1, mean age 5 years) and 36-month (Time 2, mean age 6 years) follow-up from the NET-Works obesity prevention trial (NET-Works, NCT0166891) were used. Hair cortisol measures obtained at each time point were log-transformed and regressed on economic hardship at Time 1 and a cumulative economic hardship from Time 1 to Time 2, using generalized linear regressions. All models were adjusted for child age, sex, race/ethnicity, and intervention (prevention vs. control) arm. The final analytic sample sizes ranged from 248 to 287. Longitudinal analyses indicated that for every 1-unit higher economic hardship score at Time 1, hair cortisol at Time 2 follow-up was on average 0.07 log-picograms per milligram (pg/mg) higher (95% confidence interval [CI]: 0.01, 0.13). For every 1-unit increase in the cumulative economic hardship score between Time 1 and 2, there was a 0.04 log-pg/mg (95% CI: 0.00, 0.07) average higher level of hair cortisol at Time 2 follow-up. Results show suggestive but limited evidence for an association between economic hardship and cortisol in young children.
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Estresse Financeiro , Hidrocortisona , Humanos , Criança , Pré-Escolar , Pobreza/psicologia , Estudos Transversais , EtnicidadeRESUMO
Background: The risk of pregnancy-related mortality in the United States has nearly doubled since 1990, with venous thromboembolism (VTE) accounting for approximately 10% of these deaths. Objectives: The objective of this study was to assess whether preexisting autoimmune disease is a risk factor for postpartum VTE. Methods: Using the MarketScan Commercial and Medicare Supplemental administrative databases, a retrospective cohort study analyzed whether postpartum persons with autoimmune disease had a higher risk of postpartum VTE incidence than postpartum persons without autoimmune disease. Using International Classification of Diseases codes, we identified 757,303 individuals of childbearing age who had a valid delivery date with at least 12 weeks of follow-up. Results: Individuals were, on average, 30.7 years old (SD, 5.4), and 3.7% (N = 27,997 of 757,303) of them had evidence of preexisting autoimmune disease. In covariate-adjusted models, postpartum persons with preexisting autoimmune disease had higher rates of postpartum VTE than postpartum persons without autoimmune disease (hazard ratio [HR], 1.33; 95% CI, 1.07-1.64). When analyzed by individual autoimmune disease, those with systemic lupus erythematosus (HR, 2.49; 95% CI, 1.47-4.21) and Crohn's disease (HR, 2.49; 95% CI, 1.34-4.64) were at an elevated risk of postpartum VTE compared with those without autoimmune disease. Conclusion: Autoimmune disease was associated with a higher rate of postpartum VTE, with evidence that the association was most pronounced among individuals with systemic lupus erythematosus and Crohn's disease. These findings suggest that postpartum persons of childbearing age with autoimmune disease may require more monitoring and prophylactic care after delivery to prevent potentially fatal VTE events.
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Economic hardship may lead to a wide range of negative outcomes, including violence. However, existing literature on economic hardship and violence is limited by reliance on official reports of violence and conflation of different measures of economic hardship. The goals of this study are to measure how violence-related injuries are associated with five measures of county-level economic shocks: unemployment rate, male mass layoffs, female mass layoffs, foreclosure rate, and unemployment rate change, measured cross-sectionally and by a 1-year lag. This study measures three subtypes of violence outcomes (child abuse, elder abuse, and intimate partner violence). Yearly county-level data were obtained on violence-related injuries and economic measures from 2005 to 2012 for all 87 counties in Minnesota. Negative binomial models were run regressing the case counts of each violence outcome at the county-year level on each economic indicator modeled individually, with population denominator offsets to yield incidence rate ratios. Crude models were run first, then county-level socio-demographic variables and year were added to each model, and finally fully-adjusted models were run including all socio-demographic variables plus all economic indicators simultaneously. In the fully-adjusted models, a county's higher foreclosure rate is the strongest and most consistently associated with an increase in all violence subtypes. Unemployment rate is the second strongest and most consistent economic risk factor for all violence subtypes. Lastly, there appears to be an impact of gender specific to economic impacts on child abuse; specifically, male mass-lay-offs were associated with increased rates while female mass-lay-offs were associated with decreased rates. Understanding the associations of different types of economic hardship with a range of violence outcomes can aid in developing more holistic prevention and intervention efforts.
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Maus-Tratos Infantis , Abuso de Idosos , Violência por Parceiro Íntimo , Criança , Idoso , Humanos , Masculino , Feminino , Estresse Financeiro , Violência , Violência por Parceiro Íntimo/prevenção & controleRESUMO
Interest in using internet search data, such as that from the Google Health Trends Application Programming Interface (GHT-API), to measure epidemiologically relevant exposures or health outcomes is growing due to their accessibility and timeliness. Researchers enter search term(s), geography, and time period, and the GHT-API returns a scaled probability of that search term, given all searches within the specified geographic-time period. In this study, we detailed a method for using these data to measure a construct of interest in 5 iterative steps: first, identify phrases the target population may use to search for the construct of interest; second, refine candidate search phrases with incognito Google searches to improve sensitivity and specificity; third, craft the GHT-API search term(s) by combining the refined phrases; fourth, test search volume and choose geographic and temporal scales; and fifth, retrieve and average multiple samples to stabilize estimates and address missingness. An optional sixth step involves accounting for changes in total search volume by normalizing. We present a case study examining weekly state-level child abuse searches in the United States during the coronavirus disease 2019 pandemic (January 2018 to August 2020) as an application of this method and describe limitations.
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COVID-19 , Criança , Humanos , Estados Unidos , Ferramenta de Busca , Pandemias , Estudos Epidemiológicos , InternetRESUMO
Background: The burden of infertility is serious for women in high-fertility countries. Objectives: We sought to identify demographic, behavioral/environmental, and reproductive risk factors for various infertility factors (i.e., ovarian, tubal, uterine/cervical, male/other) among women seeking infertility treatment in central Tanzania; to determine the association between pelvic inflammatory disease (PID) and tubal factor infertility (TFI); and to identify barriers to infertility treatment by women's home regional zone. Methods: We conducted a cross-sectional survey of women seeking infertility treatment in Dodoma, Tanzania from January-March 2020. We surveyed 168 participants aged 18-49 years and reviewed their medical records to confirm infertility status and potential risk factors. We estimated prevalence ratios for factors associated with infertility using logistic regression. Treatment barriers were compared by women's regional zone to see if barriers varied geographically. Results: The median age of participants was 32 years (range: 18-48). Infertility factors did not vary greatly by patient demographics, behavioral/environmental, or reproductive risk factors. Approximately 31.48% of women had PID diagnoses. Those with PID had 1.94 (95% CI: 1.30, 2.90) times the prevalence of TFI diagnosis as those with other infertility factors, after adjusting for age, pesticide use, alcohol use, age at sexual debut, prior obstetric events, and family history of infertility. Logistical barriers to treatment, such as time and cost, were more frequently reported than emotional, stigma, or other barriers, regardless of regional zone. Conclusions: PID was strongly associated with TFI after adjustment for confounders. Infertility treatment access due to cost remains a challenge in Tanzania.
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Infertilidade Feminina , Humanos , Feminino , Adulto , Tanzânia/epidemiologia , Estudos Transversais , Fatores de Risco , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Prevalência , Inquéritos e Questionários , Acessibilidade aos Serviços de Saúde , Doença Inflamatória Pélvica/epidemiologia , Prontuários MédicosRESUMO
Both schools and caregivers play an important role in supporting children's mental health, but there are few mechanisms for caregivers and school-based mental health providers to work collaboratively to address children's needs. Closures of schools during the first wave of the COVID-19 pandemic left gaps in mental health support services to children and increased the burden on caregivers to ensure their children's well-being. In this study, investigators explored the feasibility and acceptability of a motivational interviewing-based program in which school-based mental health providers were trained to connect directly to caregivers to assist them in supporting key aspects of their children's well-being, including sleep, coping, and academic behavior. Results indicated a high degree of satisfaction with the program and a perception that it was helpful to caregivers and children. However, major challenges in recruitment of providers, as well as qualitative interviews with those providers who participated, indicated that the feasibility of implementing such a program is limited without significant additional implementation infrastructure. Findings suggest that structured support of caregivers, accessed through their children's schools, has high potential for improving child outcomes and family well-being. Future research should explore what implementation infrastructure is needed for schools to effectively offer these types of supports.
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BACKGROUND: Persistent infection with high-risk human papillomavirus (hrHPV) types is a well-documented cause of cervical cancer. Since the implementation of cervical cancer screening methods (e.g., Pap tests), cervical cancer rates have declined. However, Pap tests are still unacceptable to many women and require complex infrastructure and training. Self-sampling techniques for collecting HPV specimens (or "HPV self-sampling") have been proposed as a possible alternative to overcome these barriers. The objective of this study was to capture perspectives from health care personnel (providers, leaders, and clinic staff) across primary care systems on the potential implementation of an HPV self-sampling practice. METHODS: Between May and July 2021, a study invitation was emailed to various health care professional networks across the Midwest, including a snowball sampling of these networks. Eligible participants were invited to a 45-60-min Zoom-recorded interview session and asked to complete a pre-interview survey. The survey collected sociodemographics on age, occupation, level of educational attainment, race/ethnicity, gender, and awareness of HPV self-sampling. The semi-structured interview was guided by the Consolidated Framework for Implementation Research and asked participants about their views on HPV self-sampling and its potential implementation. All interviews were audio-recorded, transcribed, and analyzed using NVivo 12. RESULTS: Key informant interviews were conducted with thirty health care personnel-13 health care providers, 6 clinic staff, and 11 health care leaders-from various health care systems. Most participants had not heard of HPV self-sampling but reported a general enthusiasm for wanting to implement it as an alternative cervical cancer screening tool. Possible barriers to implementation were knowledge of clinical evidence and ease of integration into existing clinic workflows. Potential facilitators included the previous adoption of similar self-sampling tools (e.g., stool-based testing kits) and key decision-makers. CONCLUSION: Although support for HPV self-sampling is growing, its intervention's characteristics (e.g., advantages, adaptability) and the evidence of its clinical efficacy and feasibility need to be better disseminated across US primary care settings and its potential adopters. Future research is also needed to support the integration of HPV self-sampling within various delivery modalities (mail-based vs. clinic-based).